A 10-year-old child is transported to the emergency department ...

[kfurse]

A 10-year-old child is transported to the emergency department (ED) by ambulance from the scene of a motor vehicle crash. The child is alert and oriented 3; pulse, respirations, and blood pressure are stable; neck and back are immobilized on a backboard. The nurse sees no obvious bleeding. The child states, I can't move or feel my legs. Which injury does the nurse suspect based on the current data?
 
  1. Spinal cord injury
  2. Traumatic shock
  3. Traumatic brain injury
  4. Ruptured spleen

Question 2

Which nursing intervention should the nurse include in the plan of care for a child who is sedated, unconscious, and on a mechanical ventilator?
 
  1. Out-of-bed transfer to wheelchair
  2. Whirlpool baths
  3. Maintenance of intravenous (IV) hydration
  4. Active range-of-motion (ROM) exercises

[Jadwiga9]

Answer to Question 1

1
Explanation:
1. Spinal cord injury results in paralysis and anesthesia of the affected body parts below the level of the lesion.
2. Traumatic shock results in initially increasing then decreasing pulse and respirations and falling blood pressure.
3. Altered levels of consciousness could indicate traumatic brain injury.
4. The child might have a ruptured spleen, but it is not evident from the data given in this scenario.

Answer to Question 2

3
Explanation:
1. The child would not be permitted to be transferred to a wheelchair.
2. The child would not be permitted to be transferred to take whirlpool baths.
3. The child who is unconscious is unable to take anything by mouth, and will need IV therapy for hydration.
4. The nurse may perform passive ROM exercises on the child, but the child is incapable of doing active ROM exercises.

[kfurse]

Excellent

[nyrave]

Gracias!